Abstract

Approximately 1.5% of the US population has been reported to use cocaine/heroine regularly. Up to 70% of street cocaine/heroine is contaminated with levamisole. Levamisole is a synthetic anthelminthic agent once used medically for its immunomodulatory effects: its use in the medical setting was significantly reduced in 1999 due to levamisole induced vasculitis. We present a 34-year old female with a 7-year history of non-healing 16 x 10 cm irregularly shaped ulcer on the right shin clinically thought to represent pyoderma gangrenosum. Histopathologic examination of punch biopsy specimen demonstrates ulcerated skin with small vessel vasculitis characterized by fibrinoid change of vessel walls with admixed neutrophilic inflammation and extravasation of RBCs. Additional clinical history reveals that the patient is a chronic IV heroine user and the right shin in the area of ulceration is her preferred site for injection. Therefore, the histologic features in association with history of IV drug injection to the site of ulceration is felt most consistent with a pyoderma gangrenosum – like lesion secondary to small vessel vasculitis induced by levamisole. Pyoderma gangrenosum - like lesions have been previously reported in patients with levamisole induced vasculitis and should be considered in the differential whenever pyoderma gangrenosum is under clinical consideration.

Financial Disclosure:
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